1. WAEL TANTAWY MD CONSTRECTIVE PERICARDITIS CASE PRESENTATION

2. Etiology Historically, the most common cause of conestrictive pericarditis was TB pericarditis, however, now it is rare. Other causes include recurrent episodes of viral or purulent pericarditis. post-cardiac injury/surgery. Neoplastic pericarditis, mediastinal radiation, chronic uremia, or Collagen vascular disease.

3. Echo in Constrictive pericarditis Certain echo findings are consistent with the diagnosis of constrictive pericarditis Pericardial effusion ± fibrinous adhesions. Pericardial thickening ± calcification which may appear as multiple linear & parallel echoes posterior to the LV by M-mode Abnormal septal motion: septal “bounce” diastolic “checking,” septal “shudder” “Flattening,” of the LV during mid- to late diastole, due to stiff pericardium(in 85% of pts

5. Echo in Constrictive pericarditis CONT Doppler provides further evidence of constrictive physiology. Transmitral Pulsed Doppler shows increased E velocity & reduced A-wave velocity, due to impaired late diastolic filling. Marked respiratory variation may be noted in early diastolic filling, with >25% increase of TV flow & >25% decrease of MV flow during inspiration

8. clinical presentation The clinical presentation of constrictive pericarditis is usually subtle and gradual. The Patients may C/O weakness, fatigue, & anorexia exertional dyspnea and peripheral edema. Physical findings reflect the consequences of chronically elevated heart pressures,

9. Case ICase I 40 y S/M 40 y S/M K/C of ESRD on dialysis & sever osteoprosis. K/C of ESRD on dialysis & sever osteoprosis. Presented with hypotension & SOB. Presented with hypotension & SOB. TTE done showed pericardial effusion (managed medically by increased dialysis cession) TTE done showed pericardial effusion (managed medically by increased dialysis cession) 2 months later he presented by recurrent attacks of tachy arrhythmia (S.tachycardia & SVT) 2 months later he presented by recurrent attacks of tachy arrhythmia (S.tachycardia & SVT)

16. Case II 27y male History of RTA 2y ago complicated by haemopericardium and pericardiocentesis was done twice in Rhyad. Presented with 3 months history of exertional SOB, abdomenal distention & LL oedema.

29. Case III 38Y FEMALE Exertional SOB FC II-III/IV History of flue like symptoms two weeks before Diagnosed as viral pericarditis with moderate pericardial effusion, ttt medically 6 monthes later started to have progressive exertional SOB with paroxysmal attacks of irrigular palpitation 48 h holter revealed PAF